医疗保险总额预付实施效果的实证分析  

Empirical Analysis on the Implementation Effects of Global Budget under Medical Insurance

作　　者：于雪梅[1] 江芹 郎婧婧 张振忠[1] 

机构地区：[1]哈尔滨医科大学公共卫生学院,哈尔滨150081 [2]国家卫生计生委卫生发展研究中心,北京100191

出　　处：《中国卫生经济》2017年第4期40-42,共3页Chinese Health Economics

摘　　要：目的:分析某市一家二级甲等医院医疗保险总额预付的实施效果。方法:采用定性访谈、定量数据收集的方法,对资料进行描述和推断性统计分析。结果:医疗工作量增加,医疗工作效率提高;费用控制效果不理想,总费用明显上升,次均费用上升幅度较小;医疗质量下降。结论:医保部门需科学合理制定总额与指标;医院需进一步完善总额预付制的实施与考核方案;完善监管机制,提高医疗质量。Objective： To evaluate the implementation effects of medical insurance scheme by global budget in a Secondary A hospital. Methods： Qualitative review and quantitative data collection were applied to conduct the descriptive and inferential statislics analysis. Results： The medical workload increased while the technical efficiency improved. The cost control effect was not well, the total cost increased significantly, the average cost increased slightly and medical quality decreased. Conclusion： Local medical insurance authority should scientifically formulate and rationally the total amount and index. The hospital should further improve the implemeutation and evaluation scheme of global budget, improve the supervision mechanism and perfect the medical quality.

关 键 词：职工医疗保险 总额预付 实施效果 

分 类 号：R197.3[医药卫生—卫生事业管理] F842.684[医药卫生—公共卫生与预防医学]